Extreme Makeovers… Don’t Need to Be So Extreme
Fifteen years ago, many of us watched the Extreme Makeover shows that were popular on TV. They of course involved major dental changes, mostly in the form of porcelain crowns or veneers on multiple teeth. It was amazing to see. But what a lot of viewers didn’t realize, and what patients today even don’t often realize, is what it takes to put a porcelain piece on a tooth that will not only look good, but function well and last.
In most cases, a tooth must be “shaved down” a bit in order to get a porcelain shell (veneer) or cap (crown) over it that isn’t bulky or bigger than/protruding past the surrounding teeth. This tooth shaving can be slight, if the tooth is a nice light shade and is in good position (not crowded, rotated, etc.). But the tooth needs to be drilled more if big changes are needed. This may be justified to get a good result, but the risks and benefits need to be weighed because it does involve taking away some healthy tooth structure. Furthermore, any changes or repairs to porcelain on a tooth must involve a dental lab ceramist, which incurs lab fees and additional appointments in the dental office to deliver the porcelain after the ceramist has worked on it.
Resin bonding is a cosmetic alternative to porcelain in a many cases of worn or malpositioned or even dark teeth. Its biggest advantages are less time in the dental char, $ costs, and less tooth shaving or reduction. Because composite resin tooth-colored filling material is directly chemically bonded to the tooth by hand, it can often be done simply “additively”, without any drilling of the tooth and usually without numbing the tooth. There are multiple shades and translucencies of resin that are kept in the office for layering on a given tooth to achieve a lifelike appearance. Resin bonding is also easy to adjust, remove and replace if changes or repairs need to be made over time as the new tooth contours are being tried and tested by the patient cosmetically and also functionally with eating and speaking. Resin lasts for several years in most patients, and can be transitioned into porcelain eventually if indicated for more longevity as porcelain can be a bit stronger in some cases.
We do a lot of resin bonding on front teeth in the office, whether it is to address a space a patient has always had and disliked, or to finalize cosmetics after Invisalign, and we love these fun treatments that don’t involve numbing and are quick and instantaneous. It is a move in the direction of more conservative dental work that I believe in, keeping as much of the natural healthy tooth as possible intact to keep for a lifetime.